NEW JOURNAL ARTICLES REVIEWS SURGERY FOR MORTON’S NEUROMA

Authored by Dr. Burton S. Schuler,
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It has been an open secret for years that the surgery for the excision of a Morton neuroma left a great deal to be desired

Recently there have been several articles in Medical Journals  that support this position  concerning the   problems with this surgery.

In  Long-term results of neurectomy in the treatment of Morton’s neuroma: more than 10 years’ follow-up.  Kyung Tai Lee, M.D., and  others,  Foot Ankle Spec. 2011 Dec;4(6):349-53. doi: 10.1177/1938640011428510. Epub 2011 Dec 1

 the authors stated that they  reviewed 7 different studies between  1991-2008 and  their results regarding the surgery were slightly worst than other published reports done  regarding the Morton’s neuroma surgery. They went on to say complications of the surgery included numbness and  long lasting pain. And, this pain could cause footwear restriction and a poor results of the surgery in general.

They also stated regarding numbness 

“There was a great deal of numbness reported by patients, thus we assumed that continued numbness postoperatively  may have affected the results, and could be one of several considerations, in terms of post op results.“ 

Finally Lee and his group warned the doctors reading this article  to  ‘be aware of the long term prognosis” in regard to cutting out the Morton’s Neuroma and to make sure you tell your patient’s up front about the possible long term effects from this surgery.  The doctor better cover himself  and tell the patient  from the outset that most probably they will have some numbness  at the area of surgery, permanently,  and  may have some  problems wearing shoes  permanently.

In another study regarding Morton’s  Neuroma  Surgery entitled  

Long-term Evaluation of Interdigital Neuroma treated by Surgical Excision.  Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Foot Ankle Int. 2008 Jun;29(6):574-7. doi: 10.3113/FAI.2008.0574.

 The  authors stated  that  only 51%  of the patients felt they had a good outcome  in regard to cutting out of their  Morton’s Neuroma while 40% had poor results.

In another article regard excision of Morton’s Neuroma  entitled :

The Outcome of Morton’s Neurectomy in the Treatment of Metatarsalgia  Int Orthop. 2010 April; 34(4): 511–515. Published online 2009 May  30.  doi:  10.1007/s00264-009-0812-3

The  78 patients in the study felt that after an average of  4 ½ years, over ¾  of them  still complained of numbness in their toes. While 85% still  complained of some  pain going up to to the forefoot. About ½  stated that   this pain  was relieved by rubbing the foot. But  about ½  said they were completely satisfied with the procedure. The authors did admit  that many patients did have some on ongoing  discomfort in the area of the surgery; and 7 out of 10 still have some problems wearing shoes. The study also commented that n numbness in the web space postoperativly was very common.

From the above it is clear that the  classical Morton’s  Neuroma Excision Surgery does have many intrinsic problems The good news there are other surgery available for the treatment of painful Morton’s Neuroma, that is in fact much less traumatic to the patient, with a much shorter healing time, with much less pain and can be done in the doctors office. These 3 well established surgeries  have been around for many years and have been time tested  These surgeries are so well established that the U.S. Government in  their  Agency for Healthcare Research and Quality, has included the three surgeries below as part of  The National Guideline Clearinghouse as a acceptable treatment for Morton’s Neuroma. These guidelines were developed with the help of Academy of Ambulatory Foot and Ankle Surgery.  

1. Osteotomy of adjacent metatarsal(s) may be used for intermetatarsal neuroma in the event that the metatarsal is malpositioned or malformed, and that the purpose of the osteotomy is for treatment of both the neuroma and the pathological metatarsal as well.
2. Tendon lengthening/tenotomy/capsulotomy may be used for intermetatarsal neuroma in the event that the purposeof these procedures is both for treatment of the neuroma and the soft tissue pathology.
3. Severing of the inter metatarsal ligament. 

All three of the above are proved alternatives to the standard surgical  removal of the Morton’s Neuroma.  As of this  writing most neuromas are still being cut out, with all of the side effects (ie numbness, pain) associated with it. Swelling of the feet from the above is also associated with this

 Please see my 12 minute video on neuroma if you would like to learn more about this painful problem